Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleProximity of Arthroscopic Ankle Stabilization Procedures to Surrounding Structures: An Anatomic Study
Section snippets
Methods
Ten lower extremity cadaveric specimens from the level of the knee joint distal to the toes were obtained from 10 fresh cadavers (mean age, 40 ± 12 years) and were screened for gross anatomic defects and pre-existing ankle laxity. A stress test performed on each of the specimens confirmed that less than 10° of laxity was present before testing. The other 10 lower extremity cadaveric specimens from these cadavers were used for a separate study. A 5- to 7-cm curved incision was made over the
Results
Our results indicate that several anatomic structures lie in close proximity to the ATFL and CFL sutures. The ATFL sutures entrapped significantly more structures compared with sutures in the CFL: 9 of 55 structures compared with 0 of 55 structures (P = .0017). The ATFL sutures entrapped 2 different structures in 3 of the specimens, so a total of 6 of 10 specimens had entrapped structures. The ATFL sutures entrapped the extensor tendons (2 specimens), peroneus tertius (5 specimens),
Discussion
Prevention of lateral ankle instability is paramount, given the risk of late sequelae, including degenerative arthritis.13 Many techniques have been described, including anatomic,6, 14, 15 nonanatomic,4, 16, 17, 18, 19, 20 and graft reconstruction–type procedures.16, 21 There are several advantages of an anatomic repair, such as restoring normal ankle anatomy and joint kinematics while maintaining motion of the ankle and subtalar joints.6, 14, 22 Relying on poor-quality tissue for lateral
Conclusions
In the model studied, the sutures at the location of the ATFL entrapped significantly more structures than the sutures from the CFL anchor. Our results indicate that the peroneus tertius and extensor tendons have the highest risk for entrapment and show the smallest mean distances from the anchor knot to the identified structure. Careful attention to these structures, as well as the SPN, is mandatory to prevent entrapment of tendons and nerves when one is attempting arthroscopic lateral ankle
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The authors report that they have no conflicts of interest in the authorship and publication of this article.